{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GRACE A MINOR","gend":1,"add":"724 GRAVEL HILL RD","city":"FORK UNION  ","state":"VA","zip":"23055-9998","dob":"1966-01-24","age":"","mstatus":"","insh":11012316,"cliId":"3WU7K97KT57","pno":4344146695,"cno":4344146695,"email":"","ename":"","eno":"","pphy":"LANFORD, RANDOLPH E  ","ppno":4348423244,"pcpadd":"4064 JAMES MADISON HWY","pcpcity":"FORK UNION  ","pcpstate":"VA","pcpzip":230550001,"pcpcounty":"","pcpid":"P9307347","pcpname":"FORK UNION MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"724 GRAVEL HILL RD","madd2":"","madd3":"","mcity":"FORK UNION  ","mstate":"VA","mzip":"23055-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M25.511","G89.29","M25.512","R11.2","E87.6","D72.829","R10.9","M54.5","M25.551","M25.552","R35.0","R30.0","E78.5","Z12.31","Z12.11","Z12.12","N15.1","N12","A41.9","E11.65","B96.20","R94.31","G47.00","F32.9","F41.1","F12.90","F17.210","Z96.653","Z90.710","Z79.899","I51.7","R53.83","Z86.59","E78.6","M19.012","M19.011","M77.8","F32.89","Z72.0","R11.0","R00.2","Z20.822","Z87.440","R07.9","Z53.21","N76.0","M75.21","M75.22","M75.81","M75.82","M19.019","M54.2","Z12.2","Z87.891","B37.3","M75.41","M75.42"],"date":["2021-07-20","2021-07-20","2021-07-20","2021-06-30","2021-03-16","2021-03-04","2021-03-04","2021-07-20","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-08-05","2021-02-26","2021-02-26","2021-02-26","2021-06-30","2021-04-30","2021-03-04","2021-03-04","2021-03-04","2021-03-16","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-08-30","2021-03-04","2021-03-04","2021-03-04","2021-03-05","2021-03-07","2021-03-08","2021-03-16","2021-10-22","2021-10-22","2021-06-18","2021-06-18","2021-08-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-07-01","2021-07-01","2021-03-24","2021-07-20","2021-07-20","2021-10-22","2021-07-20","2021-07-20","2021-07-20","2021-08-30","2021-08-30","2021-10-19","2021-10-22","2021-10-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","93719805","FLUOXETINE","CAP 40MG","","Select","Select",""],["","68382014005","TOPIRAMATE","TAB 100MG","","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","832532515","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","","Select","Select",""],["","93719805","FLUOXETINE ","CAP 40MG","90","Select","Select",""],["","68382014005","TOPIRAMATE ","TAB 100MG","180","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","40","Select","Select",""],["","832532515","POT  CL MICRO","TAB 20MEQ ER","180","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","20","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","3","Select","Select",""],["","68382005101","MELOXICAM ","15MG","90","Select","Select",""],["","68382005101","MELOXICAM","15MG","90","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}